Angry Doctor

Saturday, November 26, 2005

For the longest time

Came across this site while googling 'stupid patients'. I'm not endorsing any of the products on sale on the site, but I thought this story was worth reading.

Exerpt

" The fact that a patient is "mentally challenged" is not an acceptable means of defense in a malpractice trial. In reality, it is obvious that there is an increased risk of a diagnostic error being made in such a case, when the patient can give a history that is no better than that which could be obtained from an earthworm. However, malpractice defense attorneys would be loath to suggest such a thing, as this might appear as if the physician were guilty of intellectual snobbery. Actually, it's just life in the real world. People who are stupid have an increased chance of doing stupid things, and making errors in judgement (as when they are driving a car, for example) for which they may pay dearly. It is an indisputable fact that they have a higher death rate, and no amount of liberal pressure to phrase their shortcomings in euphemistically acceptable terminology is ever going to benefit them. Actually, by attempting to mitigate the stigma of the intellectually vacuous, they are perpetuating their misery. A problem cannot be overcome unless it is recognized, accepted, and dealt with. Anyone's intelligence can be improved through effort. Coddling the incompetent merely predestines them to a life in which they will never reach their true potential. "


That sounds harsh, but after a few years in this job you get really frustrated with patients not being able to tell you how roughly long they've been having that cough/pain/bleeding. And you know what? Chances are, the longer they take to remember the answer, the shorter the duration is.

9 Comments:

  • Oh in Singapore we don't do that anymore. Any non-defaulter Singaporean male doctor would have done his dues in NS. That's where you get them "answer yes" to every question the MO asks type of patients.

    Many a time my differential diagnosis in my mind for a 19 year old patient presenting with chronic cough could read :

    Ischemic heart disease
    COPD
    Peptic ulcer disease
    Stroke
    Possible neoplasia given the history of hemoptysis, loss of weight, loss of appetite

    Of course we don't send all these hundreds of guys daily to the Specialists!

    But after doing that for 2 years, you kinda learn some tricks to handle these "mentally challenged".

    By Anonymous Dr Oz bloke, At November 26, 2005 9:16 am  

  • ah...the pleasures of treating a patient with vague pains...

    all body pen pen!

    By Blogger andrew, At November 26, 2005 12:40 pm  

  • This is quite disheartening. One would think that with all the intelligence & hard work that it takes to get accepted into medical school, the admissions comittee would at least choose people with a heart, some common sense, and the tiniest inclination of empathic understanding whether it be towards one's own culture, or the remotest culture on the face of this globe. I, on the other hand, may be part of the intellectually vacuous group of people who hope, forgive how utopian this ideology may seem, that physicians are capable of creating change in the world around them without disregarding all those around & below them.

    By Anonymous Anonymous, At November 26, 2005 1:14 pm  

  • *scratches head*

    eh? like wtf is anonymous talking about?

    hehheh.

    it's absolutely mind-bogglingly infuriating dealing with patients who don't know enough to, or just plain won't, tell you about their medical conditions.

    sometimes, i ask patients "how long have you had diabetes?" and theyy say "you're the doctor! you go and check in the records lah!"

    mahai.

    By Anonymous distinguished mediocrity, At November 26, 2005 3:45 pm  

  • This is quite heartening. One knows that with all the intelligence & hard work that it takes to get accepted into medical school, the admissions committee would choose people with a heart, some common sense, and the inclination of empathic understanding whether it be towards one's own culture, or the remotest culture on the face of this globe. I, am part of this intellectually adequate group of people who hope, forgive how utopian this ideology may seem, that patients are responsible, logical and understanding beings, and attempt as well as they can to communicate to doctors their problems. Doctors are not mind readers and do indeed admit that they humbly need help from the patients to treat them properly.

    We however also hope that such an admission by doctors does not cause patients to disregard and look upon their doctors as inferior and incompetent.

    And in the event that this utopian wish fails, the patients can hopefully understand that the doctor will use whatever means, symphathetic or unsympathetic, logical or illogical to help find the root of their problems and help them. Or else the alternative choice would be to simply give up hope and abandon these group of uncommunicative mentally challenged patients, letting fate and destiny take its course.

    I believe that as difficult as it may be, doctors will try their mortally human best.

    Lastly always remember that doctors are NOT GODS. They are also not the embodiment of Jesus Christ. They are but humble servants of the lord.

    By Anonymous Dr Oz bloke, At November 26, 2005 4:11 pm  

  • You had to go back to the 80s to come up with that story? I see it every day. I'm not a doctor, I work in a supportive allied health profession, and one thing I was taught is that we are to promote the independance of our patients. Sadly, our patients have no interest in being independant. What they want is to be cared for, to be waited on hand and foot. More than once I have asked one "so, who wipes your ass when you're at home?" My sarcasm is usually lost on them and I know it's inappropriate but I can't help it. It's too bad that your story is written in what sound to me as an African-American vernacular, and political correctness would require that the language be fixed up a little, but if presenting reality is offensive to some there's probably not much that can be done for them.

    By Blogger The Platypus, At November 26, 2005 11:33 pm  

  • Short of going hi-tech and inserting a microchip in ev.one to track the medical records, and medication taken in each person...
    How about the Health Promotion Board start educating the young students to learn to be responsible for their health? Young Children tend to be obedient patients, and thus listen to the Dr's advice, ya? ... There's a chance that the parents will be influenced by their children as well. :)
    With more awareness, the patients will stop listing u the colors of the pills, and at least bring the medication to the Dr if they can't pronounce the tongue-twisting names of the med.

    Viola! Angry Dr's problem solved! :)

    By Anonymous Anonymous, At November 28, 2005 11:25 am  

  • Being the author of that story, I am compelled to make a few comments:

    1. In regard to "It's too bad that your story is written in what sound to me as an African-American vernacular, and political correctness would require that the language be fixed up a little" and "Yes, I too detect a racist undertone in Dr Pezzi’s account." I never mentioned the patient's race, so if you reflexively assume that the quoted speech is indicative of a certain race, then you might question whether you possess some racial stereotypes that lead you to make that assumption. Second, I think it is ludicrous to suggest that I am racist. My www.ERbook.net site is huge, so it is understandable that you missed something in it, but in that site I presented a sure-cure for racism . . . or if not a sure-cure, then it is far better than the usual ineffectual approaches.

    2. In regard to "This is quite disheartening. One would think that with all the intelligence & hard work that it takes to get accepted into medical school, the admissions comittee would at least choose people with a heart, some common sense, and the tiniest inclination of empathic understanding ..." You are missing the point. The idealism and good intentions of most medical students is decimated (at least in the United States) after years of practice, and years of butting your head up against the wall. I used to think that I could change the world, or at least my part of it, but the denizens would still shoot and stab one another for a variety of insane reasons, such as "I want your tennis shoes." It's wonderful to see (or infer) that some doctors retain that idealism, but most don't. Decimation of idealism is also a problem in nurses. I have several friends who are nurses, and when I hear them speak behind closed doors about patients and how they've "had it" (and more!), I think, "Compared to them, I AM idealistic!" Burnout is very common in healthcare practitioners, yet the onus for dealing with this is usually left to the individual. That's not a good approach, in my opinion. Many of these problems are systemic and affect virtually every practitioner, so why not do the logical thing and attempt to solve or mitigate the problem instead of bellyaching about practitioners who become burned out as a result of the problem?

    3. Finally, a message to "angry doc": Copyright laws permit short quotations and comments, not lengthy reproduction of a story, as you did. It's standard practice and legally permissible in blogging to have a short excerpt and a link to the original source. Taking as much as you want and linking to the source does not absolve you of culpability, so please replace your posting of my material with an excerpt and link instead of expropriating the entire story. Thank you!

    By Blogger Kevin Pezzi, MD, At November 29, 2005 10:23 pm  

  • Dr Pezzi,

    I apologise for causing offence.

    My 'racist' comment did not refer to the manner of speech of the patient, but the 'American Indian' remark. In any case, I apologise - it is unfair for me to make that comment based on that one remark.

    I will replace the posting with an exerpt and a link as required by you and post an entry apologising for my actions.

    Thank you for your feedback.

    By Blogger angry doc, At November 29, 2005 10:53 pm  

Post a Comment

Subscribe to Post Comments [Atom]



Links to this post:

Create a Link

<< Home